1083624167 NPI number — MORRILTON HEALTHCARE CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083624167 NPI number — MORRILTON HEALTHCARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRILTON HEALTHCARE CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083624167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11350 MCCORMICK RD
Provider Second Line Business Mailing Address:
SUITE 503 EXECUTIVE PLAZA III
Provider Business Mailing Address City Name:
HUNT VALLEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-527-4083
Provider Business Mailing Address Fax Number:
410-527-4081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 BROOKRIDGE LA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRILTON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-354-4585
Provider Business Practice Location Address Fax Number:
501-354-1257
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUTTERWORTH
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
410-527-4083

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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